Obstetric fistula

While the prevalence of Obstetric Fistula in the East and Southern Africa region is unknown, it is estimated that two million women in sub-Saharan Africa, Asia, the Arab region, Latin America and the Caribbean are living with this injury. An estimated 50,000 to 100,000 new cases develop each year. Yet the condition is almost entirely preventable. Its persistence is a sign that health systems are failing to meet women’s essential needs.

While the prevalence of Obstetric Fistula in the East and Southern Africa region is unknown, it is estimated that two million women in sub-Saharan Africa, Asia, the Arab region, Latin America and the Caribbean are living with this injury. An estimated 50,000 to 100,000 new cases develop each year. Yet the condition is almost entirely preventable. Its persistence is a sign that health systems are failing to meet women’s essential needs.

Obstetric fistula is a direct result of obstructed labour, one of the major causes of maternal deaths. This is where the mother’s pelvis is too small for the baby to be delivered without help. Obstetric fistula happens during a long and obstructed labour. The pressure caused by the obstructed labour damages the tissue of the internal passages of the bladder and/or rectum. With no access to a Caesarian section and emergency obstetric care, the woman may be left permanently incontinent. This means being unable to hold urine or faeces, which leak out through her vagina. In about 90 per cent of cases, the baby does not survive, which means the mother has to deal with the devastating internal injuries on top of her loss.

A fistula can usually be repaired with reconstructive surgery. Most women affected by this injury do not know about the treatment available, however, or they are unable to afford it or to reach the facilities where it is available. Once a woman has been treated, she may also need counselling and skills training to help her reintegrate into her community.

The causes of fistula
 

The physical causes are limited access to health care, including essential obstetric care during pregnancy and childbirth, adolescent fertility (early marriage), and existing harmful practices such as female genital mutilation (FGM), which affect the normal delivery process.

Obstetric fistula is still increasing because health systems fail to provide essential and emergency obstetric care during pregnancy and childbirth, including family planning and the affordable treatment of fistula.

The poor integration of sexual and reproductive health (SRH) services for adolescents and comprehensive SRH packages into existing national health systems also contributes to fistula. Young couples need opportunities to postpone their first pregnancy, avoid early pregnancy and space births.

The key to ending fistula is prevention. This entails ensuring that all women have access skilled birth attendants and emergency obstetric care if they develop complications during delivery. Additionally, the provision of family planning to those who want it could reduce maternal disability and death by at least 20 per cent.

UNFPA’s response
 

UNFPA and its partners launched the Global Campaign to End Fistula in 2003 to redress the unacceptable human rights and equity dimensions of obstetric fistula. Since the campaign started, UNFPA has helped more than 20,000 women and girls to access fistula treatment and care.

UNFPA aims to increase its role through the provision of technical and programme support to reinforce National Task Forces for Fistula and in supporting UNFPA Country Offices to help them integrate the sexual and reproductive health (SRH) programme component with activities on obstetric fistula. This assistance is mainly supported by the Maternal Health Thematic Fund (MHTF).

UNFPA provides medical supplies, training and funds for fistula prevention, treatment and social reintegration programmes. The Fund also strengthens maternal health and emergency obstetric services to prevent this injury from occurring in the first place.

The majority of UNFPA Country Offices has conducted a needs assessment for fistula. Most UNFPA country programmes are supporting fistula prevention – by reinforcing EmONC, maternity waiting homes and midwifery programmes – and treatment, providing equipment and supplies, and training providers.

However, there is a strong need to mobilize human resources in the region to increase access to treatment services and address growing backlogs. Most country programmes have in place either a stand-alone or integrated national coordination mechanism to support fistula programming and to create and promote national policies, strategies and guidelines.